Living with Bulimia Nervosa
-Maiken Wiese, RD, East Coast Director of Nutrition for Eating Disorder Recovery Specialists (EDRS)
If you have bulimia nervosa, you are not alone. Bulimia affects 1.5% in women and 0.5% in men in the United States. In other words, approximately 4.7 million females and 1.5 million males will have their lives threatened by this potentially deadly disorder. The good news is, bulimia is treatable and recovery will help you slowly take back control.
As a person struggling with bulimia you may find yourself conducting your behaviors in secret, which produces shame and disgust during a binge, but a sense of relief following a purge. Those who suffer from bulimia tend to maintain normal weight; however, they may fear gaining weight, have desire to lose weight, and may feel intensely dissatisfied with their bodies.
You can often feel like you’ll never escape from bulimia because without the right guidance and support it can be impossible to believe that there is a light at the end of the tunnel. But with the right set of tools — psychotherapy, dietitian, and other professional medical support — you will be able to reach a place of recovery and peace in your life.
What is Bulimia Nervosa?
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines Bulimia Nervosa in this way:
Recurrent episodes of binge eating characterized by BOTH of the following:
- Eating in a discrete amount of time (within a 2 hour period) large amounts of food.
- Sense of lack of control over eating during an episode.
- Recurrent inappropriate compensatory behavior in order to prevent weight gain (purging).
- The binge eating and compensatory behaviors both occur, on average, at least once a week for three months.
- Self-evaluation is unduly influenced by body shape and weight.
- The disturbance does not occur exclusively during episodes of anorexia nervosa.
First it’s important to note the misconceptions about this disorder, in order to get closer to the facts. Here are a few myths about bulimia:
Myth: It’s easy to spot. Because the nature of bulimia is based on eating / overeating, the person suffering from bulimia tends to not lose weight, due to a bingeing and purging cycle. The person may also use excessive exercise as a way to maintain their weight, so visibly they will not appear drastically different.
Myth: It’s all about weight. Eating disorders don’t show up in otherwise emotionally healthy individuals. While weight appears to be the primary issue outwardly, bulimia develops from a combination of psychological, social, and biological factors. These include anxiety, depression, and lack of self-confidence.
Myth: It’s the parents’ fault. A dysfunctional home life is not a direct cause of bulimia, though genetics can play a key role, along with other biological factors, psychological traits, and even cultural experiences.
Treatment for Bulimia
Psychological counseling and medication (antidepressants) are two of the main approaches to treating bulimia. Treatment does not usually require staying in the hospital, although this is sometimes needed. Poor self esteem and negative body image are often at the root of bulimia and therapy is focused on the following:
- Stopping the binge-purge cycle: Start by breaking this dangerous cycle and restoring normal eating patterns.
- Eliminating negative thoughts: Recognize and change irrational perceptions regarding dieting, weight, and body shape.
- Healing emotional issues: Working through emotional issues that may be the cause of bulimia. Treatment may address interpersonal relationships and can include cognitive behavior therapy, dialectic behavior therapy, and other related therapies.
Bulimia Nervosa Complications
You may suffer from other medical complications, which can occur along with bulimia nervosa. They are related to too much vomiting or overuse of certain medications.
Most of these problems will go away when the bingeing and purging behaviors stop.
Complications of bulimia include:
Dehydration. Can cause dizziness, low blood pressure, and dark-colored urine. Lack of hydration may lead to a hospital stay if untreated.
Tooth enamel Erosion / Gum Disease. This is caused by the acidity of vomit. It can lead to sensitive teeth and cavities.
Swelling of glands in the cheeks. This leads to the appearance of “puffy” cheeks. It’s often painless, but not always.
Irregular periods. Menstrual periods, if they’ve started, may become erratic.
Miscarriage. For pregnant women, bulimia may result in losing the fetus.
Constipation. May produce bloating, abdominal pain, inability to have a bowel movement.
Esophagus / upper stomach damage. This happens because of frequent vomiting.
Diabetes. Some studies have shown that the risk of developing diabetes is twice as high in bulimics as in the general population.
Muscle damage. Heart muscle / skeletal muscle damage may occur. The issue can be severe if you’re using ipecac syrup to make yourself vomit.
Note: Always treat blood in your vomit (or your stool) as an emergency. Blood in your vomit may look like coffee grounds, and blood in your stool may be black and look similar to tar.
A Closer Look: Causes
Dr. Robin Rosenberg, clinical psychologist, discusses the causes of eating disorders and notes that it is not uncommon for people to move from one diagnosis to the other. She notes some potential causes that are common threads in anorexia, bulimia and binge eating disorders — like influence of cultural. “One of the things that is clear is the influence of culture, in that our culture is pretty screwed up about body ideal, especially for women. And it is hard to be a young woman or an older woman in our society and have a positive relationship with your body because of the cultural messages about how women should look, which is basically unattainable unless it is a full-time job or you have a lot of plastic surgery.”
Bulimia, like the other disorders, has a complex etiology. Family dysfunction, genetics, attachment ruptures, mood disorders, trauma, and environment may all play a role.
It’s also serious. According to NCBI (“Bulimia Nervosa: A Primary Care Review”), it states, “In more severe cases, bulimics may alter daily schedules to be assured of time for bingeing and purging. They may also deprive themselves of food for hours before the binge, and it is thought that this deprivation plays into the ritualistic pattern of bulimic eating. Because regular binges may be costly, food may be stolen from grocery and convenience stores. The severity of weight and eating attitudes may fuel the frequency of binge and purge behaviors. It is these behaviors that may lead to serious medical and psychiatric complications.”
Carmosino, A. (2020). Living with Bulimia Nervosa. Psych Central. Retrieved on September 19, 2020, from https://psychcentral.com/eating-disorders/living-with-bulimia-nervosa/